Eyal Cohen, MD, MSc, FRCP(C)Associate Scientist and Program Head (interim), Child Health Evaluative Sciences
Research Institute, The Hospital for Sick Children
Staff Physician, Division of Paediatric Medicine, The Hospital for Sick Children
Professor, Paediatrics and Health Policy
Management & Evaluation
The University of Toronto

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Having a child with a major birth defect can be a life-changing and stressful event for the child’s mother. This stress may be associated with higher risk of premature cardiovascular disease.

We found that mothers of infants born with a major birth defect had a 15% higher risk of premature cardiovascular disease that a comparison group of mothers. The risk was more pronounced, rising to 37% among mothers who gave birth to a more severely affected infant (and infant born with major birth defects affecting more than one organ system). The risk was apparent even within the first 10 years after the birth of the child.

A 97-year-old female patient was suffering from multiple squamous cell carcinomas varying from small to incredibly large in size on both of her legs. She was injected with the HPV vaccine commonly known as Gardasil, which is also used to treat warts and oral papilloma. She was first injected in her arm, and then after a period of six weeks, the vaccine was directly injected into her tumors. It was observed that this treatment eventually killed off almost all the tumors on her legs. According to recent press coverage, she is now looking forward to celebrating her 100th birthday in fall 2018.

MedicalResearch.com: What is the background for this study?Is HPV thought be a trigger for some cutaneous squamous cell carcinomas?

Response: The link between skin cancers and HPV vaccinations has normally been investigated in patients who have received organ transplants. Due to the immune-suppressant drugs these patients must take, it is incredibly common to find cases of skin cancer in patients who have undergone transplants. The relaxed immune system, which would normally eliminate cancers caused by the HPV virus, would open the floodgates for multiple skin tumors to emerge. In this case of the 97 year old, I would assume her immune system was healthy. There is, however, growing evidence that receiving multiple vaccines for the HPV virus is necessary even in patients with healthy immune systems. So, regardless of immune health, I believe we need to expand the frequency of the HPV vaccine, even beyond the current three-tiered system for women below 26 and men below 21.

Response: Dietary supplements lead to an estimated 23,000 emergency department visits each year in the United States (US), and weight loss and sports supplements contribute to a disproportionately large number of these emergency department visits. It is not known which ingredients in weight loss and sports supplements pose the greatest risk to consumers, but there are stimulants found in botanical remedies that might pose risks.

In the current study, we investigated the presence and quantity of higenamine a stimulant found in botanicals and available in sports and weight loss supplements sold in the US.

Response: Despite decades-long reductions in cardiovascular disease (CVD) mortality, CVD mortality rates have recently plateaued and even increased in some subgroups, and the prevalence of CVD risk factors remains high. Million Hearts 2022, a 5-year initiative with a goal of preventing one million heart attacks, strokes and other acute cardiovascular events by 2022, was launched in 2017 to address this burden. This report establishes a baseline for the CVD risk factors targeted for reduction by the initiative during 2017–2021 and highlights recent changes over time.

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: For over three decades, paramedics have performed endotracheal intubation (ETI) as the standard advanced airway management strategy in cardiac arrest. However, intubation is a difficult and error-prone intervention. Newer supraglottic airways such as the laryngeal tube (LT) offer easier insertion technique with comparable ventilation. However, intubation and laryngeal tubes have not been tested head-to-head in a randomized trial.

We found that compared with traditional ETI, LT was associated with almost 3% better survival. Out-of-hospital cardiac arrest survival in the US is less than 10%, so the observed difference is important.Continue reading →

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: We performed this study to compare two methods of replacing a diseased aortic valve in young and middle-aged adults: using an artificial mechanical valve (mechanical aortic valve replacement) versus using the patient’s own pulmonary valve (Ross procedure).

The study was a meta-analysis of existing literature that included more than 3,500 adult patients. It found that those who underwent the Ross procedure were 46 per cent less likely to experience death from any cause than patients who underwent mechanical aortic valve replacement. Patients in the Ross group were also less likely to suffer from a stroke or major bleeding, and had better quality of life. Patients who underwent the Ross procedure were more likely to need late reoperation, but this did not negatively impact their survival. Continue reading →

Response: Oxygen has been used to treat patients suffering a heart attack for more than a century, despite the fact that such treatment has not had any scientifically proven effect on patients who have normal oxygen levels in their blood. Since the turn of the millennium, researchers worldwide have started to question whether oxygen therapy for heart attacks is ineffective – or may even be harmful.

-By definition a secondary MR concerns a normal valve or sub normal valve inside a dilated heart with poor LV function in a population of Heart failure patients. It is perfectly established today that secondary MR is a predictor of poor clinical outcomes of thissevere population.

-Therefore,it has been proposed to treat those regurgitation either by surgery (mainly the downsizing anuloplasty) or by percutaneous technique like the mitraclipwhich has been used more and more frequently recently.

-However, a beneficial effect on hardclinical outcomes has never been provedandwe still don’t know if those regurgitations need to be corrected or not, We still don’t Know if the regurgitation is the cause, the consequence or just a marker of poor prognosis.

-In this context according to the guidelines, there is a low level of evidence to support those treatments, and Europe and US Guidelines call for prospective randomized studies in this severe population.​

Sheep tick – vector for Coxiella burnetii, the cause of the disease known as Q fever CDC image

Pr. Didier RaoultDirecteur de l’IHU Méditerranée-Infection
Marseille

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: This work represents the sum of data accumulated over several decades of studies on Q fever.

Our reference center contacts each of the physicians in charge and ensures patient follow-up, which allows obtaining data, that is not comparable to those used automatically in databanks. Four people exclusively dedicated their time to manage these specific data on Q fever.

The main data confirm the need to perform a cardiac ultrasound for all patients with Q fever and acute endocarditis (to detect valvulopathy) and to give a prophylactic treatment to avoid fixation on the heart in patients with valvulopathy.

This work helps clarify the evolution of Q fever by eliminating the term of chronic Q fever, which is based on non-clinical elements, and defining persistent Q fever for which there is an identifiable focus of infection.

Furthermore, this work makes it possible to recommend systematic detection of antiphospholipid antibodies in order to limit the risk of thrombosis and the risk of cardiac fixation.

Prof David Newby FRSE FMedSciPersonal Chair – BHF John Wheatley Chair of Cardiology
University of Edinburgh

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: There are many tests that can try and determine whether a patient has heart disease. All are imperfect and do not directly see if the heart arteries are diseased.

This study used a CT heart scan to see if there was any heart disease in patients who presented to the outpatient clinic with chest pains that could be due to coronary heart disease. The doctor use the scan result to decide whether they had heart disease and how to manage the patient.

The study has found that if you use a CT heart scan then you are less likely to have a heart attack in the future. In the first year, you may require treatment with an angiogram and heart surgery (stent or heart bypass) but after the first year, you are less likely to need these treatments because the disease has already been treated promptly.

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: There has been growing work in medicine which suggests both that a) women are more skilled physicians across a variety of ailments and b) women are particularly challenging heart attack patients (for a variety of reasons ranging from delays in seeking treatment to atypical presentation). When you coupled this with the deep literatures in economics, sociology, and political science which suggests that advocatees experience better outcomes when they share traits with their advocates, it seemed plausible that there might be differences in outcomes.

The key finding is that gender concordance matters most for female patients: female patients are about 0.7-1.2% more likely to die if treated by a male doctor, relative to a female doctor. This number seems small. But, if the survival rate among the female heart attack patients treated by male doctor was the same as the survival rate among female heart attack patients treated by female doctors, about 1,500-3,000 fewer of the female heart attack patients in our sample would have passed away. Our sample covers the state of Florida from 1991-2010. Florida is about 10% of the US population. Continue reading →

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Previous research has demonstrated that heart diseases and brain diseases share common risk factors. Favorable health factors (optimal levels of BMI, blood pressure, blood glucose and cholesterol) and behaviors (non smoking, physical activity and diet at optimal levels), which are known to protect the heart, have also been associated with a lower risk of age-related brain diseases (eg, dementia) and lower rate of cognitive decline in some epidemiological studies. However, studies have been controversial and importantly, very limited research has considered risk factors simultaneously. This may be an explanation for the lack of established consensus for recommendations aimed at dementia prevention.

This study adds to previous knowledge by evaluating cardiovascular health factors and behaviors simultaneously in relation to cognitive decline and the risk of dementia in older age. We used the American Heart Association 7-item tool to promote primordial prevention, which aims to prevent the developement of risk factors in a first place as a prevention strategy against cardiovascular diseases.

We found that each additional favorable health factor/behavior was associated with a 10% lower risk to develop dementia in the following decade.

These findings support the promotion if cardiovascular health to prevent the development of risk factors associated with dementia.

MedicalResearch.com: What should readers take away from your report?

Response: When considering cardiovascular health, each additional improvement of the level of one or several health factors/behaviors is associated with a lower risk opf dementia and less cognitive decline.

MedicalResearch.com: What recommendations do you have for future research as a result of this work?

Response: Evaluate the change in risk factors over time as well was possible differential weighting of the factors in relation to dementia risk.

The information on MedicalResearch.com is provided for educational purposes only, and is in no way intended to diagnose, cure, or treat any medical or other condition. Always seek the advice of your physician or other qualified health and ask your doctor any questions you may have regarding a medical condition. In addition to all other limitations and disclaimers in this agreement, service provider and its third party providers disclaim any liability or loss in connection with the content provided on this website.

Response: For patients who present to the hospital with symptoms suggestive of acute coronary syndrome (ACS) the preferred blood test to help physicians in making a diagnosis is cardiac troponin.

Recent studies have demonstrated that a very low or undetectable cardiac troponin level when measured with the newest generation of blood tests (i.e., the high-sensitivity cardiac troponin tests) in this population may rule-out myocardial infarction (MI or a heart attack) on the initial blood sample collected in the emergency department, thus enabling a faster decision and foregoing the need for subsequent serial measurements of cardiac troponin over several hours as recommended by the guidelines. The problem with this approach, however, is that using high-sensitivity cardiac troponin alone to do this has not reliably been demonstrated to achieve a sensitivity >99% for detecting MI, which is the estimate that most physicians in this setting consider as safe for discharge.

Our study goal was to compare the diagnostic performance of a simple laboratory algorithm using common blood tests (i.e., a clinical chemistry score (CCS) consisting of glucose, estimated glomerular filtration rate (eGFR), and either high-sensitivity cardiac troponin I or T) to high-sensitivity cardiac troponin alone for predicting MI or death within the first month following the initial blood work. Continue reading →

Response: Patients with type 2 diabetes have 2 to 4 times greater risk for death and cardiovascular events compared to the general population. There are several randomized trails that encourage a range of interventions that target traditional and modifiable risk factors, such as elevated levels for glycated hemoglobin, blood pressure and low-density lipoprotein cholesterol to reduce the risk for complications of type 2 diabetes. However, there are few randomized trails that have investigated the effects of multifactorial risk factor intervention in reducing the risk for death and cardiovascular events, as compared to patients that are treated with usual care.

We set out to investigate the extent to which the excess risk associated with type 2 diabetes may be mitigated or potentially eliminated by means of evidence-based treatment and multifactorial risk factor modification. In addition, we estimated the relative importance between various risk factors and the incremental risk of death and cardiovascular events associated with diabetes. Furthermore, we investigated the association between glycated hemoglobin, systolic blood pressure and low-density lipoprotein cholesterol (LDL-C) within evidence based target ranges and the abovementioned outcomes.

Seth Landefeld, M.D. Dr. Landefeld is chairman of the department of medicine and the Spencer chair in medical science leadership at the University of Alabama at Birmingham (UAB) School of Medicine.
Dr. Landefeld also serves on the board of directors of the American Board of Internal Medicine, the UAB Health System, and the University of Alabama Health Services Foundation.

MedicalResearch.com: What is the background for this study? Would you briefly explain what is meant by atrial fibrillation and whom it primarily affects?

Response: Atrial fibrillation—or AF—is an irregular heartbeat. AF affects nearly 3 million Americans and is a leading cause of stroke. Older age and obesity increase the risk of AF, and the condition also occurs more in men than in women. With an aging society and the growing prevalence of obesity in the U.S., this was an important topic for the U.S. Preventive Services Task Force to review.

The Task Force looked at the latest research to see if screening for atrial fibrillation using electrocardiography—or ECG, which is a test that records the activity of someone’s heart—to supplement traditional care is an effective way to diagnose AF and prevent stroke.

We found that more research is needed to determine if screening with ECG can help to identify AF and prevent stroke in adults who are 65 and older and do not have signs or symptoms of the disease.Continue reading →

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Atrial fibrillation (AF) describes intermittent or permanent episodes of irregular pulse, due to rapid electrical activity within the atria (filling chambers) of the heart. During AF, the atria quiver, rather than contract, and the response of the ventricles is often rapid, resulting in palpitations and an increased risk of development of heart failure. AF may occur at any age, but is most common in ageing patients (typically over 75 years). The primary importance of AF is that it markedly increases the risk of thrombus formation in the atrium, with the resultant problem that these thrombi may dislodge (embolise), and commonly block arteries in the brain, causing strokes. Hence patients with AF are usually treated with anticoagulants.

Although AF often occurs in patients with prior damage to their hearts and atrial distension, there has been evidence for about the past 8 years that AF also is caused, at least in part, by inflammatory changes: two components have been identified as possible causes for this inflammation: lack of nitric oxide (NO) effect[ NO is an anti-inflammatory chemical formed by all tissues in the body], and excess activity of the pro-inflammatory enzyme myeloperoxidase (MPO). High concentrations of ADMA, which inhibits NO formation, may result from effects of MPO on tissues. SDMA, which is closely related to ADMA, also exerts pro-inflammatory effects and tends to suppress NO formation.

The currently reported study began with the design of the ARISTOTLE trial, an investigation of the (then) novel anticoagulant apixaban as an alternative to warfarin therapy, as a means of preventing strokes in patients with AF. It was elected to perform a substudy to investigate the potential role of ADMA and SDMA as modulators of risk in patients with atrial fibrillation.

This substudy, performed in just over 5000 patients from the ARISTOTLE trial, essentially asked two questions:

(1) There are several indices of stroke risk in patients with atrial fibrillation, such as the CHADS2 score. These all rely on patient characteristics (eg age, presence of diabetes) rather than chemical changes. We postulated that there would be a direct relationship between clinically based risk scores and ADMA/SDMA concentrations.

(2) More ambitiously, we postulated that ADMA and SDMA concentrations would represent INDEPENDENT risk markers for major adverse effects in atrial fibrillation patients on anticoagulant treatment, namely stroke, major bleeding and risk of mortality.

ADMA/SDMA concentrations were determined in Adelaide, Australia, while statistical analyses were performed in Uppsala, Sweden.

Response: The drug-induced long QT syndrome (diLQTS) is a problem for clinicians balancing risk and benefits across multiple therapeutic areas, and for pharmaceutical scientists and regulators evaluating new drug candidates. The prevalent view is that block of a specific ion current, the rapid component of the cardiac delayed rectifier (IKr), is the common mechanism predisposing to diLQTS across drug classes and that patients with mutations in ion channel genes are at especially increased risk. In the very extreme form of diLQTS, a specific form of ventricular arrhythmia potentially lethal, called Torsade de Pointes, can occur. All IKr blocking drugs do not confer the same Torsade de Pointes risk; the risk with antiarrhythmics such as sotalol or dofetilide can be 1-2%, while the risk with IKr-blocking antibiotics such as moxifloxacin is much lower, <1/20,000.

Women are at higher risk of diLQTS than men. Androgens are protective. Influence of hormonal contraception on diTdP and QT prolongation is controversial

MedicalResearch.com: Were you surprised by the study findings, why or why not?

Response: We were not really surprised because the influence of testosterone (the main androgenic hormone) to shorten the duration of cardiac repolarization was already known. We wanted to see if this effect was also present with contraceptive pills with various androgenic-like activities.

MedicalResearch.com: Can you explain what exactly is “sotalol-induced QTc prolongation”?

Response: After each heartbeat, the heart recovers to normal. This phenomenon is called ventricular repolarization and can be assessed on the electrocardiogram by measuring the duration of a parameter called QT interval. This QT interval is influenced by many factors one of them being heart rate. QT interval is therefore corrected for the heart rate observed at the time of its measurement (QTc). Sotalol is one of several drugs given to prolong ventricular repolarization, and hence QTc, as a mean to prevent the recurrence of some disturbances of heart beats. These disturbances are called arrhythmias. However, drugs which prolong QTc can also provoke a very rare arrhythmia which can cause cardiac arrest or the heart to stops. Only rare susceptible patients are at risk of having this drug-induced arrhythmia and most patients who receive sotalol and have prolonged QTc are doing well.

MedicalResearch.com: What were the drug-induced alterations in “ventricular repolarization” seen among the women?

Response: The alterations of ventricular repolarization were those expected with sotalol: prolongation of QTc interval and changes is the morphology of the T-wave which is part of the QT interval. What we found is that the extent of QTc prolongation and T-wave morphological changes caused by sotalol was greater in women who were receiving the anti-androgenic contraceptive pill drospirenone compared with levonorgestrel. This is in line with the known effect of androgens to shorten ventricular repolarization in men but it was not known to be influenced by the progestin androgenic activity of oral contraceptives in women.

MedicalResearch.com: What new information does this study provide to the scientific literature on oral contraceptives?

Response: We did not show that oral contraceptives influence ventricular repolarization. This was not the purpose of the study. Our study, with its limitations, suggests that the type of oral contraceptive can influence the effects of drugs such as sotalol which prolong QTc. Drospirenone, an oral contraceptive with antiandrogenic properties, was associated with greater drug-induced QTc prolongation than levonorgestrel, an oral contraceptive with androgenic activity. Whether this is associated with a greater risk of provoking arrhythmias with antiandrogenic pills is not proven although there are indirect indications from an analysis of the European pharmacovigilance database, that this might be the case. Additional studies need to be performed to better assess this risk.

MedicalResearch.com: What were some limitations of the study?

Response: The type of oral contraceptive taken by women participating in the study was prescribed by their physician and women receiving different oral contraceptives may have differed in their response to sotalol for other reasons. In other words, oral contraceptives were not administered by chance to the women (the study was not randomized but observational) and this is not the most robust method to examine the influence drugs in general. Also, the level of the natural sex hormones in the blood of the study participants was not measured and it may have influenced QTc interval

MedicalResearch.com: Why is this study important?

Response: In spite of its limitations, our study prompts for a more thorough assessment of the influence of progestin androgenic activity of oral contraceptives on drug-induced QTc interval prolongation and the risk of associated arrhythmias. It also emphasizes the importance of androgens as a factor limiting the risk of QTc prolongation in patients receiving drugs which prolong ventricular repolarization.

The information on MedicalResearch.com is provided for educational purposes only, and is in no way intended to diagnose, cure, or treat any medical or other condition. Always seek the advice of your physician or other qualified health and ask your doctor any questions you may have regarding a medical condition. In addition to all other limitations and disclaimers in this agreement, service provider and its third party providers disclaim any liability or loss in connection with the content provided on this website.

Response: Heart failure is a very common medical condition impacting roughly 6 million men and women in the United States, and associated with impaired quality of life, frequent hospitalizations, and high rates of death.

There are over 300,000 deaths each year in the US among patients with heart failure. Half of heart failure patients have heart failure because of a weak heart muscle where the heart cannot eject a normal amount of blood with each heartbeat, a term called “reduced ejection fraction.” Fortunately, there are multiple medications proven in large clinical trials to make people with heart failure with reduced ejection fraction live longer and feel better.

We also have target doses for these medications, which are the doses used in the trials where the medication proved its benefit. These medications and the target doses are strongly recommended in professional guidelines to improve patient outcomes.

To make sure patients have the best outcomes possible, it is important that we work to get patients on these proven medications if at all possible. Unfortunately, prior research has suggested that many patients eligible for these medications in regular outpatient practice do not receive them.

Most of this research is several years old, and there have been a lot of efforts to improve the quality of heart failure care in the meantime. In our study, we wanted to see if there have been improvements in the use and dosing of proven heart failure medications in modern-day practice. We also wanted to determine which patient factors were associated with not receiving a medication, or receiving the medication at a below target dose.

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Many studies haves shown associations between cardiometabolic health and dementia in midlife, but associations later in life remain inconclusive.

This study aimed to model concurrently and to compare the trajectories of major cardiometabolic risk factors in the 14 years before diagnosis among cases of dementia and controls.

This study showed that demented persons presented a BMI decline and lower blood pressure (specifically systolic blood pressure) several years before dementia diagnosis that might be a consequence of underlying disease. In contrast, cases presented consistently higher blood glucose levels up to 14 years before dementia suggesting that high glycemia is a strong risk factor for dementia.

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Randomized trials are the best evidence basis we have to treat patients. It is known for more than 20 years that older adults and women are disproportionately excluded from randomized trials in cardiology diseases. As the current US population is fast aging, we examined whether this underrepresentation improved or worsened in the last 20 years in the most influential studies published between 1996 and 2015.

The main finding is that the women and older adults continue to be underrepresented in cardiology trials. Overall, the mean age was 63 years and the percentage of women was 29%. For coronary heart disease, women comprise 54% of the US population in need of treatment, yet are only 27% of the trial population. For heart failure, the median age of older adults in the US population is 70 years whereas it is only 64 years in the trial population.

Our results indicate that the gap has very slowly narrowed in the last 2 decades. However, based on current trends, reaching proportionate enrollment would require between 3 and 9 decades. This persistent lack of representation has significant impacts on the ability of clinicians to provide evidenced based care for these segments of the population. Physicians and other health care professionals are forced to extrapolate study results from younger and male-predominant populations. This is problematic since we know that older adults and women may react differently to medications and to interventions.Continue reading →

MedicalResearch.com: What is the background for this study? What are the main findings?

Response:It is increasingly understood that patients with heart disease are getting older and sicker. In Canada, over 5.7 million people are estimated to be aged over 65 years and as a result a greater number of older adults often complex other health issues are now require cardiac procedures. This places some patients, particular those who are more frail at a higher vulnerability to poorer postoperative outcomes and a complicated recovery process after cardiac surgery. In addition, such patients experience a reduced quality of life as a result of loss of the ability to independently perform activities of daily living (i.e. as cooking, cleaning, bathing activities, toileting etc).

During the preoperative waiting period, the cardiac symptoms and anxiety induces inactivity that in turn compounds the physical and mental deconditioning. In order to improve the functional capacity and enhance postoperative recovery, prehabilitation (“prehab”), a component of the Enhanced Recovery Protocols (ERPs), may be of particular importance.

Prehabilitation (a.k.a. “prehab”) has been described as a preoperative cardiac rehabilitation intervention, a combination of exercise training, education, and social support, affecting patients’ physical and psychological readiness for surgery with the overarching goal to reduce postoperative complications and hospital length of stay as well as ideally improving the transition from the hospital to the community. Continue reading →

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: A lot of people are interested in healthy living, but often we don’t have that discussion in the doctor’s office,” says Dr. Manuel, who is also a professor at the University of Ottawa. “Doctors will check your blood pressure and cholesterol levels, but they don’t necessarily ask about lifestyle factors that could put you at risk of a heart attack and stroke. We hope this tool can help people — and their care team — with better information about healthy living and options for reducing their risk of heart attack and stroke.”

“What sets this cardiovascular risk calculator apart is that it looks at healthy living, and it is better calibrated to the Canadian population,” says Dr. Doug Manuel, lead author, senior scientist at The Ottawa Hospital and a senior core scientist at the Institute for Clinical Evaluative Sciences (ICES).”Continue reading →

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